Healthcare Provider Details

I. General information

NPI: 1982736187
Provider Name (Legal Business Name): VARIETY CHILDREN'S HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/12/2007
Last Update Date: 10/29/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3100 SW 62ND AVE ALLERGY & IMMUNOLOGY
MIAMI FL
33155-3009
US

IV. Provider business mailing address

PO BOX 863941
ORLANDO FL
32886-3941
US

V. Phone/Fax

Practice location:
  • Phone: 305-662-8334
  • Fax: 305-663-6868
Mailing address:
  • Phone: 305-662-8334
  • Fax: 305-663-6868

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207KA0200X
TaxonomyAllergy Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. TIMOTHY BIRKENSTOCK
Title or Position: SVP & CFO
Credential:
Phone: 305-669-6422